Classifying Ketamine – what it means if K moves from C to B

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Simon Cotton does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Sometimes it seems you’ve only got to turn around and there is another drug in the news. Now we are told that ketamine should be upgraded from being a Class C drug to a Class B drug. Why does this matter?

Ketamine isn’t another “designer drug”, one that is made especially for people to use to obtain a “high”. Instead it was designed by chemists more than half a century ago for use as an anaesthetic. Somewhat ironically, its development followed concerns about the side-effects encountered with another anaesthetic, phencyclidine, better known as PCP or “angel dust”, which became a street drug of abuse, surfacing in Los Angeles in the 1970s.

Ketamine is used both on humans and animals. It is a very effective anaesthetic and painkiller that has been used safely throughout that period. Unlike other anaesthetics, its use does not result in collapse of airways, which makes it very useful in the field, where it is difficult to administer oxygen, in situations such as battlefields or for victims of traffic accidents.

In low doses it can be used as a local anaesthetic and in some cases can be used alongside opiates as an effective painkiller. It has even put forward as a potential treatment for depression. It’s also the most common substance used to anaesthetise horses – hence it being popularly referred to as a horse tranquiliser.

Psychotropic effects

After ketamine came into medical use, it was found that some patients coming round from ketamine-induced anaesthesia experienced psychotropic effects, reporting “near-death” or “out of body” experiences as well as other strange sensations, like floating or flying – sometimes pleasant, sometimes unpleasant. People said they had experienced the feeling of being peaceful and detached from life, of travelling through a dark tunnel only to emerge into a world of light, and even of “seeing God”.

It was therefore not entirely surprising that ketamine was soon being abused in the US, just a few years after it was introduced. Some believe this was due to returning Vietnam veterans who had been treated with the drug.

It has been abused in the UK over the past 20 years – first in the dance scene in the 1990s – and the Home Office estimates that around 120,000 people now take it each year in England and Wales. The Independent Scientific Committee on Drugs has said recreational use of ketamine appeared to be a growing problem. Although it didn’t call for ketamine to be reclassified, the committee suggested in 2011 that the drug was wrongly classified as less harmful than ecstasy and cannabis. It is also of increasing concern in other areas of the world such as Hong Kong.

Drugs often take on street names and while ketamine is often just called “ket”, some refer to it as “special K” – but I certainly wouldn’t recommend it for breakfast.

Difficult to manufacture

Ketamine is a difficult chemical to manufacture, so there is no risk of it being made in illegal labs in peoples’ kitchens, as with methamphetamine. It seems the ketamine on the market may be obtained mainly from legal manufacturers (especially in Asia or from chemical companies in Europe.

There have been concerns about ketamine abuse for years. Fatalities have resulted, sometimes from combining it with stimulants, for example cocaine or ecstasy, sometimes from combining it with alcohol.

The complication that has recently gained publicity, first recognised about six years ago, is the potential damage caused to the kidneys and bladder. Ketamine-induced ulcerative cystitis is an emerging disease. Early symptoms include blood in the urine and the need to urinate more frequently than usual, as well as incontinence. Some regular ketamine users have required surgery, sometimes even needing to have their bladders removed, meaning that they will never again be able to urinate normally. This is not a problem with therapeutic use of ketamine.

These considerations weighed heavily on the Advisory Council on the Misuse of Drugs, which has suggested to the government that ketamine should be reclassified as a Class B drug, in the same classification as amphetamines, with penalties for its use of, potentially, several years in jail.

They have also suggested that restrictions might be introduced on legal medical use of ketamine, meaning it has to be kept under lock and key, which could present problems. When it comes to investigations into ketamine’s potential to treat depression, it’s in no one’s interest to make potentially important research even more difficult.

Still, the dangers of misuse have shown this is by no means a safe drug and this is what the government will now need to consider along with the size of the problem. This should involve good research into who takes it, how many take it and how much they take.